One size does not fit all. How universal standards for normal height can hide deprivation and create false paradoxes

Hruschka, Daniel J.

doi:10.1002/ajhb.23552

Cited by 18 publications

(18 citation statements)

References 81 publications

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“…Taking the evidence collected in this study into account, it is necessary to reconsider whether using the same standards for all populations worldwide is accurate enough. If the growth velocities of children in different countries are not alike, as has been shown in several studies including our own, using the same international charts for all populations can easily lead to a misdiagnosis, overestimating or underestimating the rates of malnutrition (Hruschka, 2020; Natale & Rajagopalan, 2014). For example, if the height of children in one country is naturally below the mean of the WHO reference charts, we could be overestimating the rates of children with stunted growth (low H/A).…”

Section: Discussionmentioning

confidence: 81%

“…However, there is no doubt that there is human variability at a genetic and phenotypic level among the different populations that inhabit the planet. In fact, according to different studies and systematic reviews, the global variability of anthropometric measures between countries is remarkable (Hruschka, 2020; Natale & Rajagopalan, 2014; NCD Risk Factor Collaboration, 2019; Subramanian et al, 2011).…”

Section: Introductionmentioning

confidence: 99%

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Growth patterns of normo‐nourished Afghan, Haitian and Congolese children aged 6–59 months: A comparative study

et al. 2021

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Objectives International growth charts have been used in the past decades to identify atypical growth and diagnose the nutritional status of individuals. The aim of this study was to construct and compare growth patterns of normo‐nourished children between 6–59 months from Afghanistan, Haiti, and the Democratic Republic of the Congo, to assess if it would be worth developing growth charts at a national level. Methods We used an international sample of 46 466 subjects (53.7% female; 46.3% male) from the aforementioned regions. To create the growth charts, we used different statistical methodologies: the Lambda‐Mu‐Sigma (LMS), LMSP, and LMST models, and regression models based on fractional polynomials. The LMSP models were the ones that fitted our data best and were therefore the ones used to make comparisons between countries using percentiles (3rd, 50th, and 97th). Results We found that Haitian children were both, taller and heavier than their Afghan and Congolese equals of the same ages. Moreover, differences were bigger in the highest percentiles (i.e., 97th percentile). These differences might be the result of the influence that genetics and diverse social and environmental contexts have on growth rates. Conclusions Using the same international reference standards for all populations could result in the overestimation or underestimation of the proportion of malnourished children. In light of our results, we recommend the future development of national and regional growth charts to provide health workers with more precise tools to evaluate the nutritional status in the child population.

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Section: Discussionmentioning

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Growth patterns of normo‐nourished Afghan, Haitian and Congolese children aged 6–59 months: A comparative study

et al. 2021

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“…Contemporary height growth standards incorporate children from a greater range of geographic and socioeconomic contexts to encompass a wider range of ontogenetic variation [ 26 ]. However, bone-specific growth standards are available for a limited diversity of modern children [ 96–98 , 106 , 147 ] As predominantly middle- to upper-class Euro-American children and adolescents are represented in these reference datasets, comparisons to other global populations past or present are inherently limited, potentially skewing interpretations and results [ 148 ] Ideally, regional-specific standards would be developed [ 148 ]. Additionally, as both contemporary and past populations faced nutritional and other socioeconomic challenges, greater investigation of bone dimensions among groups facing socioeconomic challenges would clarify the amount of skeletal variation that may arise under these circumstances.…”

Section: Bridging Measurements Past and Presentmentioning

confidence: 99%

A growth area

Decrausaz

Cameron

2022

Evolution, Medicine, and Public Health

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Studies of living children demonstrate that early life stress impacts linear growth outcomes. Stresses affecting linear growth may also impact later life health outcomes, including increased cardiometabolic disease risk. Palaeopathologists also assess the growth of children recovered from bioarchaeological contexts. Early life stresses are inferred to affect linear growth outcomes, and measurements of skeletal linear dimensions alongside other bioarchaeological information may indicate the types of challenges faced by past groups. In clinical settings, the impacts of stress on growing children are typically measured by examining height. Palaeopathologists are limited to examining bone dimensions directly and must grapple with incomplete pictures of childhood experiences that may affect growth. Palaeopathologists may use clinical growth studies to inform observations among past children, however, there may be issues with this approach. Here, we review the relationship between contemporary and palaeopathological studies of child and adolescent growth. We identify approaches to help bridge the gap between palaeopathological and biomedical growth studies. We advocate for: the creation of bone-specific growth reference information using medical imaging and greater examination of limb proportions; the inclusion of children from different global regions and life circumstances in contemporary bone growth studies; and greater collaboration and dialogue between palaeopathologists and clinicians as new studies are designed to assess linear growth past and present. We advocate for building stronger bridges between these fields to improve interpretations of growth patterns across human history and to potentially improve interventions for children living and growing today.

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“…For analyses, we used population-specific cut points to define chronic disease outcomes, when such cut points have been recommended (for obesity and type 2 diabetes) [35]. Obesity was defined using the World Health Organization recommended body mass index (BMI) cut off of > 24.9 kg/m 2 for Asian populations [36]; high waist circumference was defined as > 35 in [37].…”

Section: Chronic Disease Outcomesmentioning

confidence: 99%

Labor migration is associated with lower rates of underweight and higher rates of obesity among left-behind wives in rural Bangladesh: a cross-sectional study

et al. 2021

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Background Among Bangladeshi men, international labor migration has increased ten-fold since 1990 and rural to urban labor migration rates have steadily increased. Labor migration of husbands has increased household wealth and redefined women’s roles, which have both positively and negatively impacted the health of wives “left behind”. We examined the direct and indirect effects of husband labor migration on chronic disease indicators and outcomes among wives of labor migrants. Methods We collected survey, anthropometric, and biomarker data from a random sample of women in Matlab, Bangladesh, in 2018. We assessed associations between husband’s migration and indicators of adiposity and chronic disease. We used structural equation modeling to assess the direct effect of labor migration on chronic disease, undernutrition, and adiposity, and the mediating roles of income, food security, and proportion of food purchased from the bazaar. Qualitative interviews and participant observation were used to help provide context for the associations we found in our quantitative results. Findings Among study participants, 9.0% were underweight, 50.9% were iron deficient, 48.3% were anemic, 39.6% were obese, 27.3% had a waist circumference over 35 in., 33.1% had a high whole-body fat percentage, 32.8% were diabetic, and 32.9% had hypertension. Slightly more women in the sample (55.3%) had a husband who never migrated than had a husband who had ever migrated (44.9%). Of those whose husband had ever migrated, 25.8% had a husband who was a current international migrant. Wives of migrants were less likely to be underweight, and more likely to have indicators of excess adiposity, than wives of non-migrants. Protection against undernutrition was attributable primarily to increased food security among wives of migrants, while increased adiposity was attributable primarily to purchasing a higher proportion of food from the bazaar; however, there was a separate path through income, which qualitative findings suggest may be related to reduced physical activity. Conclusions Labor migration, and particularly international labor migration, intensifies the nutrition transition in Bangladesh through increasing wealth, changing how foods are purchased, and reducing physical activity, which both decreases risk for undernutrition and increases risk for excess adiposity.

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One size does not fit all. How universal standards for normal height can hide deprivation and create false paradoxes

Cited by 18 publications

References 81 publications

Growth patterns of normo‐nourished Afghan, Haitian and Congolese children aged 6–59 months: A comparative study

Growth patterns of normo‐nourished Afghan, Haitian and Congolese children aged 6–59 months: A comparative study

A growth area

Labor migration is associated with lower rates of underweight and higher rates of obesity among left-behind wives in rural Bangladesh: a cross-sectional study

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